Registered nurses’ experiences of communication with patients when practising person–centred care over the phone: a qualitative interview study

Boström et al. BMC Nursing (2020) 19:54 https://doi.org/10.1186/s12912-020-00448-4 RESEARCH ARTICLE Open Access Registered nurses’ experiences of communication with patients when practising person–centred care over the phone: a qualitative interview study Eva Boström1* , Lilas Ali2,3, Andreas Fors2,3,4, Inger Ekman2,3 and Annette Erichsen Andersson2 Abstract Background: To explore registered nurses’ (RNs’) experiences of practising person-centred care (PCC) by telephone with people diagnosed with chronic obstructive pulmonary disease and/or chronic heart failure. Methods: Qualitative interview study. Four RNs were individually interviewed before, during, and after participating in an intervention practising PCC by telephone. The interviews were analysed using qualitative content analysis. Results: The results reflect three categories of their experience: realize the complexity of practising PCC by distance, gain insight into what PCC communication meant to RNs and their approach, and develop the professional role by practising PCC theory and ethics. Conclusions: PCC over the telephone facilitate healthcare and support patients. Through careful listening, the RNs (1) created space for the individual patients to express their thoughts and feelings and (2) emphasized each patient’s capabilities and resources. The RNs also gained an understanding of PCC and what it means to patients and to themselves as practitioners. Potential implications are that it is important for RNs practising PCC by telephone to remould their role, to listen carefully, and to communicate as equals in conversations that respect both parties’ knowledge and expertise. Health professionals need supervision and support to fully understand the person-centred approach and provide communications that support it. Keywords: Person-centred care, Professional role, Telephone, Qualitative Background With increased life expectancy, the non-communicable chronic diseases that often accompany ageing, and limited financial and human resources [1, 2], a worldwide need exists for new ways to deliver healthcare. Computerized health systems (eHealth), which include telehealth (video or telephone conversations) [3] can provide sufficient care to some populations and have been suggested as a promising solution [1]. People with chronic illnesses * Correspondence: 1 Department of Nursing, Umeå University, Umeå, Sweden Full list of author information is available at the end of the article such as chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) have a high symptom burden and require frequent hospitalization [4]. COPD is currently the fourth leading cause of death worldwide and is predicted to be the third by 2020 [5]. Telehealth in terms of phone support has been reported to be efficient and manageable for patients with CHF [6] and deemed relevant for people living with COPD [7]. Telephone support in general has been described by RNs to be characterized by careful listening, holistic assessments and thereto handle stressful communication [8, 9]. Research have found that telephone support includes © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Boström et al. BMC Nursing (2020) 19:54 ethical dilemmas due to talking through a third party [10] and that RNs have to recompense for the lack of visibility [11]. A review examining person-centred phone support indicated a positive impact on patients’ healthrelated quality of life [12] and a more recent study showed that telephone support significantly reduced depression symptoms and increased self-efficacy among people with COPD [13]. Registered nurses’ (RNs) provision of home support by telephone for people with CHF has been reported to allow patients a more equal role in care planning and decision making [14] and a more active role in their self-management [15]. Person-centred care (PCC) is based on a relationship of mutual respect and equality [16, 17]. This relationship is fostered in health care by professionals’ use of active listening to patients, considering the patients’ narratives along with results from medical tests and examinations as the basis for jointly formulated health care plans. Patient narratives help professionals identify patients’ internal and external resources, expectations, possibilities, and barriers [16, 17]. PCC for patients with CHF has been evaluated in several studies and shown to be both beneficial from the patients’ perspective [18, 19] and cost-effective [20]. PCC requires a fundamental change in care that emphasizes mutual respect between professionals and patients and recognition of ethical–moral behaviour [16]. Previous research by the authors in PCC showed that professionals remould their position as medical experts [16, 21], and go beyond usual care to co-create individual care with each patient, reflecting both of their perspectives [22, 23]. Telehealth can be a way to improve care for people with chronic illnesses. Such communications, conducted according to PCC values, could make patients more equal and active partners in their own care. Telehealth provides promising new ways to deliver healthcare, but how RNs practice PCC in clinical work, especially at a distance by telephone, is still largely unknown. This study will contribute to an understanding of how RNs respond to and interact within an intervention employing PCC over the telephone. Methods Aim The aim of this study was to explore RNs’ experiences of practising PCC over the telephone with people diagnosed with COPD and/or CHF. Design This qualitative descriptive interview study focused on RNs’ experiences of practising PCC by distance was a sub-study within a larger randomized controlled trial (RCT) Care for Ourselves [24]. Page 2 of 8 Participants and recruitment A convenient sample of four RNs, all women, employed at a research ward at Sahlgrenska University Hospital/ Östra, Gothenburg, Sweden and, all of them who were (...truncated)